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The Environment and Healthy Aging: The Role of Preconception and Prenatal Exposures

The Environment and Healthy Aging: The Role of Preconception and Prenatal Exposures. Patrice Sutton, MPH Research Scientist Program on Reproductive Health and the Environment. Healthy Pregnancies Healthy Children Healthy Future Generations.

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The Environment and Healthy Aging: The Role of Preconception and Prenatal Exposures

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  1. The Environment and Healthy Aging: The Role of Preconception and Prenatal Exposures Patrice Sutton, MPH Research Scientist Program on Reproductive Health and the Environment Healthy Pregnancies Healthy Children Healthy Future Generations Healthy Aging Starts at Conception: Promoting Health Across the Lifespan March 11, 2011

  2. Program on Reproductive Health and the Environment Mission To create a healthier environment for human reproduction and development Advance scientific inquiry, clinical care, and health policies that prevent exposures to harmful chemicals in our environment http://prhe.ucsf.edu/prhe/

  3. Environmental Influences on Reproductive Health Chemicals Built & Social Environment Genetics Nutrition 3

  4. Critical and Sensitive Windows of Development Blastocyst Embryo Fetus Infant Child Adolescent Periconception Prenatal Postnatal Environmental Exposure Immediate & Long Term Consequences Childhood 

  5. Developmental Origins of Adult Disease “ It is suggested that poor nutrition in early life increases susceptibility to the effects of an affluent diet” Barker DJ, Osmond C. Infant mortality, childhood nutrition, and ischaemicheart disease in England and Wales. Lancet. 1986 May 10;1(8489):1077-81.

  6. Developmental Origins of Adult Disease: Nutrition Human evidence from study of Dutch famine during WW II Maternal under-nutrition during gestation had important effects on health in later life The timing of the nutritional insult determined which organ system is affected Painter RC, Roseboom TJ, Bleker OP.Prenatal exposure to the Dutch famine and disease in later life: an overview. Reprod Toxicol. 2005 Sep-Oct;20(3):345-52.

  7. Prenatal Nutrition and Adult Health Outcomes • Exposure in early gestation: three-fold increase in coronary heart disease, more obesity • Exposure in mid-gestation: increase in obstructive airways disease • Exposure in late gestation: impaired glucose tolerance A large body of experimental and epidemiologic data have substantiated and further refined scientific understanding of these linkages Painter RC, Roseboom TJ, BlekerOP.Prenatal exposure to the Dutch famine and disease in later life: an overview. ReprodToxicol. 2005 Sep-Oct;20(3):345-52; Warner MJ, Ozanne SE. Mechanisms involved in the developmental programming of adulthood disease. The Biochemical journal. 2010 May 1;427(3):333-47; Newbold R, Heindel J. Developmental exposures and implications for disease. In: Woodruff TJ JS GJL, Giudice LC, editor. Environmental Impacts on Reproductive Health and Fertility. Cambridge, UK: Cambridge University Press; 2010. p. 92-102.

  8. Developmental Origins of Adult Disease: Chemicals DES (Diethylstilboestrol) In utero chemical exposures caused delayed reproductive health impacts “Proof of principle” of adult disease from prenatal exposure to endocrine disrupting chemicals (EDCs) Newbold, R.R., Lessons learned from perinatal exposure to diethylstilbestrol. Toxicol Appl Pharmacol, 2004. 199(2): p. 142-50.; Ibarreta D, Swan SH. The DES story: long-termconsequences of prenatalexposure. In: European Environment Agency. 2001. Late lessons from early warnings: The precautionary principle 1896—2000. Environmental Issue Report No. 22. Luxembourg: Office for Official Publications of the European Communities.http://reports.eea.europa.eu/environmental_issue_report_2001_22/en 8

  9. Percentage of U.S. Pregnant Women with Detectable Level of Analyte Based on analysis of representative sample of U.S. population by NHANES 2003-2004. Note, not all women were tested for all chemicals Source: Woodruff TJ, Zota AR, Schwartz JM 2011. Environmental Chemicals in Pregnant Women in the US: NHANES 2003-2004. Environ Health Perspect :-. doi:10.1289/ehp.1002727 Contemporary Prenatal Exposure to Endocrine Disrupting Chemicals Persistent environmental contaminants that enter the food system

  10. Prenatal Exposure to Environmental Chemicals: Health Outcomes Over Lifespan • Exposure to chemicals during fetal development can increase the risk of adverse health consequences across lifespan • Adverse birth outcomes (e.g. preterm birth and birth defects) • Childhood morbidity (e.g. neuro-developmental effects and childhood cancer) • Adult disease and mortality (e.g. cancer and cardiovascular effects) Gluckman PD, Hanson MA. 2004. Living with the past: evolution, development, and patterns of disease. Science 305(5691):1733-1736.; Stillerman KP, Mattison DR, Giudice LC, Woodruff TJ. 2008. Environmental exposures and adverse pregnancy outcomes: a review of the science. ReprodSci 15(7):631-650.

  11. Pesticide Exposure During Pregnancy and Childhood Leukemia • Pesticides at Home • Systematic review and meta-analysis 15 human studies • Exposure during pregnancy positively associated with childhood leukemia • Pesticides at work • Systematic review and meta-analysis 31 human studies • Exposure during pregnancy was positively associated with childhood leukemia Turner MC et al. Environ Health Perspect. 2010; Wigle DT et al. Environ Health Perspect. 2009.

  12. From Endocrine to Metabolic Disruption • Hypothesized that environmental chemicals can act as “metabolic” disruptors • In vitro, in vivo and human studies link exposure to EDCs with obesity, metabolic syndrome • Prenatal exposure to hexachlorobenzene and obesity in children • Prenatal exposure to DDE and increased body mass in adult women Casals-Casas C, Desvergne B. Endocrine disruptors: from endocrine to metabolic disruption. Annu Rev Physiol. 2011 Mar 17;73:135-62.

  13. Strength of the Evidence • Leading scientists, reproductive health providers & other health care practitioners have called for timely action to prevent harm • 2008 Faroes Statement • 2008 Proceedings of University of California, San Francisco and Collaborative on Health and the Environment Summit on Reproductive Health and the Environment • 2009 Endocrine Society Statement • 2010 President’s Cancer Report Woodruff TJ, Carlson A, Schwartz JM, et al. Proceedings of the Summit on Environmental Challenges to Reproductive Health and Fertility: Executive summary. FertilSteril 2008;89:e1-e20.; Grandjean P, Bellinger D, Bergman A, Cordier S, Davey-Smith G, Eskenazi B, et al. The faroes statement: human health effects of developmental exposure to chemicals in our environment. Basic & clinical pharmacology & toxicology. 2008 Feb;102(2):73-5.

  14. Taking Action To Prevent Harm • Clinical Arenas • Professional societies • Professional journals/publications/education • Outreach and education • Policy Arenas • Chemicals Policy • Food system policy

  15. Summary • Environmental chemicals and other environmental exposures can harm or nurture human reproduction • Preconception and prenatal environmental exposures can influence the risks of disease and disability across the lifespan • Timely action in clinical and policy arenas is needed to prevent harm 15

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